Lyme Disease: Causes, Testing and Treatment

Ó 2005 Karl Poehlmann and Katherine Poehlmann, Ph.D. 


Lyme Disease is one of the least understood and misdiagnosed conditions prevalent today. Although formally recognized in the late 1980s, it is an ancient disease. Lyme Disease (LD) and other tick-borne illnesses like Rickettsial Disease (e.g., Rocky Mountain Spotted Fever), Babesiosis, and Ehrlichiosis exhibit a full range of arthritis-like symptoms. LD has achieved epidemic status in some areas of the United States and continues to spread, with some 15,000 new cases reported annually. The actual number of cases may be much higher. (A full discussion of LD and infections other than mycoplasma appears in Chapter 5 of Rheumatoid Arthritis: The Infection Connection).

A comprehensive set of web links to important papers on Lyme/Borrelliosis, related co-infections, testing, diagnosis and treatment is found at For a free Lyme newsletter and more information, see:  Borrelia can shift from the spirochete form into a cell-wall-deficient (CWD) spheroblast (cyst) L-form. Its intracellular forms infect human endothelial cells and they also infect immune system Macrophages, i.e., lymphocytes, corrupting their intracellular molecular recipes, disabling parts/modes of the immune system and enhancing the virulence of other co-infections.


   The Role of Cell Wall Deficient Microorganisms

Co-infections are common. According to Dr. Garth Nicolson, who heads the Institute for Molecular Medicine (at, 60% of LD patients, 70% of those with Erlichiosis, and about 25% of those with Babesiosis also test positive for mycoplasma. Another co-infection may be Bartonella or “cat scratch disease”.

Mycoplasmas are cell wall deficient (CWD) microorganisms that are among the smallest of the bacteria, but larger than viruses and have intermediate genetic complexities.  They lack some of the ability to replicate in the absence of a living host. This is because they need the host to make some essential molecules they depend upon. They are also referred to as PPLOs (pleuro pneumonia-like organisms).  Eaton developed an agent that was later found to be Mycoplasma pneumoniae.  Mycoplasmas have a cell membrane but not a cell wall.  They have intracellular forms.  Are members of the Class/order Mollicute and are bacteria although they pass through filters originally used to distinguish viruses from bacteria.

L-form bacteria are CWD forms of bacteria that normally have a cell wall. “L” stands for the Lister institute that first discovered and named them. Streptococcus pneumonia and Mycobacteria tuberculosis have such a form. Smaller than the L-form are the intracellular forms. For example, Mycoplasmas have intracellular forms. L-forms of cell wall bacteria resemble the mycoplasmas but are different from them. Penicillin kills the cell wall form but some of the bacteria switch to CWD L-forms and continue to live in the infected host. Similarly, use of antibiotics that attack the CWD forms will stimulate transformation from L-forms into cell-wall-forms which then stimulate the re-occurrence of acute infection symptoms.

Plasmids are small virus-sized bodies that can invade bacteria and add genetic characteristics to the invaded bacteria.  For example, the resistance to tetracyclines is conveyed by a plasmid. In-vitro cultivation of the CWD form in the absence of the antibiotic will breed out the resistance factor and also reduce the virulence of the microbe to its customary animal host.


  Overcoming CWD forms and L-forms

According to Drs Baseman and Tulley, Mycoplasmas manipulate lipids (fats) in the blood and build protective shells out of material that the immune detecting cells do not recognize.  These fatty coats are similar to the waxy coats that Mycobacterium tuberculosis uses to shield itself from the antibiotics that attack it.

Broad spectrum antibiotics like tetracycline are effective against CWD forms and L-forms. They act as a chelating agent to modify the actions of metalo-enzymes, and block internal processes critical to CWD survival. Metals are grabbed by the tetracyclines as their chelation works.  For example, milk disables tetracycline by binding to the calcium.  The goal is to have the drug to react against the microbes, not be disabled in your gut. 

These antibiotics are relatively mild.  Higher doses are not effective against mycoplasmas.  As Dr. Thomas McPherson Brown discovered, low and pulsed application of tetracycline (especially minocycline) is most effective, especially in the early stages of LD.  This treatment also works against Chlamydia pneumoniae, which is an insidious, low level infection depositing arterial plaques leading to heart disease, atherosclerois, Alzheimers disease, and stroke.  Slow death results over 20 to 40 years. Sixty percent of heart attack victims show C. pneumoniae evidence, yet this infection is largely undiagnosed or treated by our doctors. (See Ongoing Reserch)

For Lyme Disease, different antibiotics in combination, tetracyclines (especially minocycline), and antifungals (perhaps tinidiazole or claforan) could be given intravenously for 3+ months until the start of remission.  LD sometimes needs treatment as long as several years (see

LD’s cyst/egg/bleb form is well known. A Google search finds some 14,000+ hits. One case history describes an acquired Lyme infection from eating tainted elk meat. Lyme Disease is a problem in Europe and our own U.S. medical establishment is rather dysfunctional and disorganized in Lyme research.  NIH/CDC gatekeepers appear to be inept or using too restrictive criteria in quantifying the extent of the epidemic. Practitioners using CDC test criteria too often deny helpful treatment for suffering patients.

Dr. Lida Mattman’s photomicrographs on CWD bacteria are shown in Cell Wall Deficient Forms—Stealth Pathogen, CRC Press, 3d edition. Boca Raton, FL. A video showing time lapse mutation of Lyme forms was shown at the Autoimmune Research Foundation’s March 2005 conference in Chicago.  BOOK FINDER  Search Old and Rare Booksellers for this book.


   The Marshall Protocol

A notable advancement in antibiotic treatment is the Marshall Protocol. (See and Dr. Trevor Marshall notes that Benicar, an angotensin release blocker, (ARB) has the property of reducing the Jarisch-Herxheimer  adverse symptoms response (see following subsection) and permitting the immune system to attack the bacteria when it is used together with a suitable tetracycline or other effective antibiotic. Pulsing of dosage on a 3 day cycle is used to force the antibiotic level to the lowest most optimal killing level.  A steady high level is often not effective against the intracellular forms. (See  One website describes various antibiotic induced transitions of the CWD, intracellular, and spirochete forms of Bb bacteria, explaining in detail reasons for chronic persistence of the infection.

There is a lot of overlap between symptoms of Fibromyalgia (FM), ALS, multiple sclerosis, chronic fatigue syndrome (CFS) and Lyme Disease.  Marshall’s protocol treats in succession a series of antibiotic-sensitive microbes that respond to different antibiotics in phases II and III of the Protocol. Some spokespersons at have some points of practical disagreement with Marshall but experience with Benicar and LD is fairly new. A Google search with keywords [Lyme Benicar Marshall] comes up with 1440 hits, so there is a lot of material to study.

Since severe Jarisch-Herxheimer reaction is often a result of effective antibiotic treatment as the microbes are killed off, and the severity of symptoms can be life-threatening, Benicar is well worth using to enhance the control of the inflammation. Marshall’s support group network can answer many questions not addressed in this article.


   Jarisch-Herxheimer Reaction (“Herx”) = Antibiotic induced worstening of symptoms.

Doctors who prescribe the antibiotic protocol usually advise the patient on diet and nutrition to help the immune system withstand the Herx symptoms. Perhaps the nutrition activates some suppressed immune modalities. For example, Vitamin C plus green tea extract (phenols) plus L-lysine and L-proline make it harder for mycoplasmas and Bb to invade the macrophages. With un-invaded macrophages, the immune system recovers from leukopenia and starts to work at about 6+ grams ascorbate or ascorbic acid per day. Vitamin C is a potent detoxifier. Several articles on the topic can be found using Google keywords [ascorbic acid Klenner]. One of the best is Observations On the Dose and Administration of Ascorbic Acid When Employed Beyond the Range Of A Vitamin In Human Pathology by Dr. Frederick Klenner.

Chondroitin is quite similar in structure to hyaluronate (hyaluronic acid) and spoofs the spreading-factor enzymes produced by the bacteria.

Marshall notes that Benicar plus the antibiotic enhances bacteria killing effectiveness and the Herx, but makes it bearable by blocking the cytokine cascade that the bacteria uses to protect itself.

It is a pity the other doctors do not use antibiotics with anti-inflammatory drugs.  Dr Brown taught this.  Marshall uses Benicar for a similar purpose, instead of prednisone.

Also a pity that doctors do not typically warn patients about side effects of antibiotics and how to compensate. I.e., the antibiotics will kill off good bacteria needed for proper digestion along with pathogenic organisms. Doctors should (but rarely do) advise patients to replenish the good bacteria with probiotics (yogurt, acidophilus, buttermilk, supplement capsules, etc.). Failing to reinstate intestinal balance can result in yeast overgrowth (Candidiasis, leaky-gut, food allergies) or serious gut conditions such as Dysbiosis and inflannation.


   Valuable Lyme-related Resources

Dr. Joseph Mercola is a DO in Chicago who has boundless energy and an incredible storehouse of knowledge. He operates the most visited website on natural medicine on the Internet, He was the source for the dietary guidelines (Appendix 5) and the physician’s reference antibiotic protocol (Appendix 2) in Rheumatoid Arthritis: The Infection Connection.  A similar resource in Maryland is Dr. Gabe Mirkin who specializes in Sports Medicine. He has a fine website run by his wife Diana who was cured of RA by use of tetracycline antibiotics with the protocol described in Appendix 2 of my book. (See

The website includes an excerpt  from An Overview of Lyme Disease and Hyperbaric Oxygen (HBO) Therapy  by Hoggard and Johnson found at www.hbotoday,com/treatment/lymedisease.shtml/  Topics:  Antibiotic Therapy: SubTopics:  Co-Infections, Testing is a Problem, Current Testing, The PCR Test, Jarisch-Herxheimer Reaction, Politics of Lyme Disease, Survival Tactics? (Cysting and Cellular Invasion)?, Alternative Health Care, Bacteriocidal/Bacteriostatic, Devastating Survival Tactics (recap), Antibiotics’ Mechanisms of Action, Discussion of medical controversy relating to Lyme Disease and its treatment.  A comprehensive overview of the problem of Lyme Disease treatment; state of the art.

An outstanding and authoritative article, When to Suspect Lyme by John D Bleiweiss, MD, written in April, 1994 appears at This 9-page article presents a complete and comprehensive symptomology of Lyme in its many presentations as they interact with other conditions, infections, and diseases. Shows much overlap with other rheumatic symptoms/diagnoses/conditions and a wide variability/extent ranging from slight to severe symptom expressions. Includes some case histories and testing results where outcome was successful.

A list of Lyme-literate MDs is given by the Lyme Disease Foundation. The date on this referral address list is October 2003.

The May 2005 Conference on Lyme 30th Anniversary (Marjorie Tietjen’s fine report). Conventional Lyme disease tests are directed at finding the spirochete form and do not work well for the L-form aka cyst form, intracellular form. With time, the L-forms with lesser detectability proliferate. Tietjen describes the patented Bowen Test QRIBb 3000X Microscopic photography florescent test for the Lyme antigen and Lida Mattman’s observations on the cell wall deficient Lyme forms. Garth Nicholson also spoke at the conference. Dr JoAnne Whitaker noted that the Bowen Test for persons diagnosed with ALS, Alzheimer’s, Lupus, CFS, Fibromyalgia, Bell’s Palsy, Multiple Sclerosis, Autism, etc. shows positive for Lyme for most if not all samples submitted.

Conventional Lyme Testing is problematic. See Igenex notes about which Lyme test to perform. As time passes, the test sensitivity drops as the pleomorphic Lyme forms shift to the smaller L-form and intracellular forms. Click on the thumbnail charts to see them in larger form. The CWD forms are antigen poor and do not have the same antigens as the spirochete form.

The consensus of the May 2005 conference is that we have a huge unrecognized, Multi-strain, poly-microbial, persistent-multi-CWD-cofactors, Lyme-disease epidemic (see zoonoses).  The microbes are spread by many biting insects, sexual transmission, mother’s milk, food, water, respiration, etc. The infections’ CWD forms are treatable with antibiotics, such as Doxycycline, streptomycin, quinine, etc. However, CDC has failed to connect the dots regarding a large number of “ mysterious” inflammatory diseases with shared symptoms, and overlapping viral, fungal and bacterial co-infections that increase each other’s virulence.

An excellent overview of Candida offers a concise discussion of fungal/yeast systemic infection, its characteristics and treatment, current information as of November 2003.  Fungal infections can contribute similar symptoms to the Lyme complex of symptoms. Both can occur together, especially when treatment includes antibiotic tetracycline and if compensating measures (probiotic supplements) are not taken.

Sugar and/or estrogen intake can facilitate Candida growth and other chronic infection modalities. Sugars of various kinds are a strain-specific, essential energy source for Mycoplasma and other CWD and intracellular forms.

An 11-page article on Lyme Disease-Induced Neurodegeneration  (Neuroborreliosis) relates the Lyme parasite to the symptoms of ALS and reports personal history of recovery from ALS diagnosis using treatments for Borrelia burgdorferii (Bb) infection. Contains lots of useful high quality links to related and supporting material. This is an outstanding summary of the neurological effects of Bb infection, its symptoms, and treatments.

Diagnosis and Therapy of Chronic Systemic Co-Infections in Lyme Disease And Other Tick-Borne Infectious Diseases by Prof. Garth L. Nicolson is an authoritative summary of Lyme Disease, containing a list of commonly detected co-infections found via testing for a wide range of patients. A table lists Lyme infection stages and antibiotic treatment commonly used.  Chronic Fatigue Syndrome, Fibromyalgia Syndrome and Other Fatigue Conditions is another excellent overview.

The merits of Pycnogenol are described in an overview article seeking alternative treatments for Lyme.

Diagnosis and Integrative Treatment of Intracellular Bacterial Infections in Chronic Fatigue and Fibromyalgia Syndromes, Gulf War Illness, Rheumatoid Arthritis and other Chronic Illnesses by Garth L. Nicolson, PhD, Marwan Y. Nasralla, PhD, A. Robert Franco, MD, Nancy L. Nicolson, PhD, et al. Clinical Practice of Alternative Medicine 2000; 1(2): 42 – 102. An overview of treatments and their outcomes for patients with poly-microbial chronic infections where frequent relapses occur when antibiotics are discontinued before total eradication is accomplished.




Dr. Poehlmann is the author of Rheumatoid Arthritis: The Infection Connection, available on and at major bookstores, or click here to order now.


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